epilepsy Flashcards
what is a seizure
it is the abnormal electrical discharge in the brain causing symptomatic manifestations
one seizure is not epilepsy but is an indication for investigations
what is epilepsy
it is when there are recurrent seizures
what is the recurrence rate of seizures after one year
70%
Epidemiology
life time risk of seizures is 5%
prevelance of seizure is 0.5%
Types of seizures
Generalised - involves both hemispheres simultaneously
Focal (partial) - activity is limited to one part of the cortex
Epilepsy starting age 35 and over usually are?
focal cerebral event
what can one tell from the symptoms and signs of a seizure
one can predict the region of brain affected
causes seizures
Idiopathic Genetic - tuberous sclerosis developmental Neoplastic (brain tumour) traumatic (head injury) infective inflammatory (vasculitis) benzodiazepine withdrawl metabolic - hypernatraemia, hypocalcaemia, ureamia, glucose fluctuations
What happens before a Tonic-Clonic seizure
Aura
What happens during a Tonic-Clonic seizure
Px goes rigid then stops breathing, cyanosed and LOC and may fall heavily
after few minutes rigidity relaxed and starts clonic jerks
Urinary incontinence or tongue biting may occur
What happens after a Tonic-Clonic seizure
Px regains consoiusness but is confused and drowsy
headaches are common
what happens in absence seizures
always start in childhood
child goes blank and stares for few seconds only and then continue as normal
maybe speaking a sentences then stops for few seconds <10s and then continue where left off
Px do not relies it is happening to them but may have many per day.
what absence seizure could be mistaken for
daydreaming
Myoclonic seizures Sx
Brief jerking movements usually in arms
occur in the morning or upon waking
what provokes myoclonic seizures
alcohol
fatigue
sleep deprivation
Atonic seizures Sx
Atonic (opposite tonic) Px briefly losses muscle tone and becomes flacid and floppy.
what can atonic seizures result in
heavy falls with or without LOC
Tonic seizures
Px has generalised increased muscle tone and is associated with LOC
Clonic seizures
Aura
tonic clonic jerks
may urinary incontinence or tongue biting
afterwards drowsy and confused
What is an aura
strange feeling in gut flashing lights strange smells deja vu usually before neuro event
What investigations should be carried after a seizures
Head CT or MRI Electroencephalography (EEG) Full bloods HIV CXR syphilis serology CSF
types of focal (partial) seizures
simple partial seizures - no LOC
complex partial seizure - with LOC –> suggests temporal lobe involvement
causes of seizures by age groups
children and teenagers - genetic and congenital disorders
younger adults - trauma drugs and alcohol
elderly >60 cerebrovascular events and neoplasms
Lifestyle management of seizures
Advice on work and risk prevention
Caution if work involves driving, heights, machinery, fires or water
legal restrictions on driving
first line drug Rx for focal seizures or secondary generalised tonic-clonic seizures (GTCS)
Lamotrigine
second line drug Rx for focal seizures or secondary GTCS
Carbamazepine Levetiracetam Sodium valproate Topiramate Zonisamide
1st line for GTCS
Sodium valproate
Levetiracetam
2nd line for GTCS
Lamotrigine
Topiramate
Zonisamide
1st line absence
Ethosuximide
2nd line absence
Sodium valproate
1st line myoclonic
Sodium valproate
2nd line myoclonic
Levetiracetam
Clonazepam
when is surgery indicated
when seizures are drug resistant
when should sodium valproate be prevented
in F of reproductive age unless benefits outweigh risks
What should you as a clinicion be aiming when giving drug Rx for seizures
use as few and simple doses as possible
ideally one drug
When drug withdrawal can be considered?
after 2 seizure free years gradual withdrawal can be considered
What is secondary GTCS
starts off as a simple seizures and evolves into a GTCS
starts with no LOC then becomes LOC and convulsions
